The New York City Department of Health has come under fire for what some are calling a "how to" pamphlet on using heroin and other intravenous drugs correctly. The Department of Health created the pamphlet, titled "Take Charge, Take Care," in 2007 in an effort to help those who use injection drugs reduce the various risks associated with drug use.
Now there is a debate over whether the pamphlet does more harm than good.
"I think tips provided in the pamphlet are not good in terms of preventing anyone from going down the road. It's enabling a user, or potential user. It implies you can use heroin in a safe manner, which is false. There is no safe way to use heroin," said John Gilbride, special agent in the field division of the Drug Enforcement Administration.
The pamphlet consists of "10 Tips for Safer Use" and describes in detail various ways for users to engage in intravenous drug use. It reminds readers to use new syringes and dispose of old ones properly. It warns them not to share needles. And it suggests ways to prevent or treat overdoses.
Several pages of the pamphlet list information on where to obtain help for addiction or sickness, such as 1-800 LifeNet or 311, New York City's public information telephone line. It also provides information on where to obtain "O.D. Kits," which provide emergency medication in the event of a potentially fatal overdose.
The booklet includes "Tip #5: Prepare Drugs Carefully," which explains in great detail how to heat heroin for use, and "Tip #6: Take Care of Your Veins," which provides instruction on how to inject the drug properly.
There are many New York area officials who agree with Gilbride but some, mainly from a public health perspective, are strong defenders of the pamphlet.
Advocates: Keep Addicts Safe
Dr. Robert Heimer, a professor at Yale University's Division of Epidemiology Microbial Diseases, says he believes the point of the pamphlet is not to promote illicit drug use, but rather to improve the quality of life for drug addicts and reduce the cost of health care treatments that arise as a consequence of HIV infection or overdoses.
"The pamphlet is factually correct and medically appropriate. Its purpose is to educate about how to prevent against diseases like HIV and hepatitis. Addicts are going to use drugs because they are addicted to them. So in the meantime, it is the goal is to keep them as healthy as possible by showing them what to do safely, and reducing the spread of disease," Heimer said.
Gilbride said the pamphlet sends the wrong message to teens and encourages drug use. "Go talk to the parents of a teenager who has overdosed from experimenting or being addicted to heroin. What do you think their views are on some of these tips? Bring a friend? Jump up and down to get your veins ready? This is a 'how to' pamphlet on how to do drugs. These tips give a false impression. It's dangerous."
Heroin 'How-To' Pamphlet Debate
But advocates of the pamphlet say it does not encourage drug use. Dr. Don Desjarlais, director of research at the Baron Edmond Rothschild Chemical Department at Beth Israel Medical Center, says drug use in New York has actually declined in recent years.
"The pamphlet is part of a larger effort to get people in the city into drug abuse treatment, and injection drug use in New York City over the last 15 years during this effort has declined," he said.
"The pamphlet has a specific target audience which does not include youngsters who are thinking about trying heroin or other intravenous drugs," said Heimer. "It was not distributed in any setting where there are large numbers of middle or high school students. Teenagers these days are more likely to see explicit heroin use in a rated 'R' movie than they are to come across this pamphlet."
The New York City Department of Health reports that accidental overdose is the fourth leading cause of early adult death in New York City, claiming more than 600 lives a year. Additionally, one third of those living with HIV contracted the virus through injection drug use.
"The pamphlet provides potentially lifesaving advice for people until they get into treatment," says the health department. The first page of the pamphlet is a warning message: "Get Help and Support to Stop Using Drugs -- Call 1-800-LifeNet or 311 Anytime Day or Night."
Booklet Far Cheaper Than HIV Infection
The cost of the pamphlet is also controversial -- more than $32,000. Many think the city of New York wasted valuable dollars on a pamphlet that sends the wrong message.
"I think it's indefensible and a waste of taxpayer funds. Just about anything would be a better use of money than this. Issuing a government guide which purports the use of heroin is grossly irresponsible," said New York City Councilman Peter F. Vallone, Jr.
Desjarlais disagreed, saying the $32,139 spent on the pamphlets was much less than the $2-300,000 it can cost to treat any one individual with HIV or AIDS.
Heimer said, "If it prevents just 10 people from getting an abscess, or one person from getting HIV, or just one overdose death, the pamphlet would have paid for itself many times over."